Clinical Presentation of Covid-19

“The Thousand Faces Disease”

PAPDI WEBINAR, 13 APRIL 2020

ADITYO SUSILO

DIVISI PENYAKIT TROPIK DAN INFEKSI, IPD

FKUI / RSCM / RSUI

11 April 2020

CFR 8,5 %

New cases

Indonesia

Gugus Tugas Penanganan COVID 19

Pathogenesis of the 1000 Faces Disease

- ACE 2 Receptor

- Tissue Organ ??

CYTOKINE STORM

Vascular System

The first remarkable finding was that ACE2 was present in endothelial cells from

small and large arteries and veins in all the tissues studied.

Respiratory System / LRT / URT

Marked ACE2 immunostaining was found in type I and type II alveolar epithelial

cells in normal lungs. Bronchial epithelial cells howed weak positive

In nasal and oral mucosa and the nasopharynx, ACE2 are expressied in the

basal layer of the non-keratinizing squamous epithelium.

Digestive System

ACE2 localization in the smooth muscle cells and endothelium of vessels from

the stomach, small intestine, colon, and in smooth muscle cells of the

muscularis mucosae and the muscularis propria. ACE2 was abundantly present

in the enterocytes of all parts of the small intestine including the duodenum,

jejunum, and ileum,

Dermal System / Skin

ACE2 was present in the basal cell layer of the epidermis extending to the

basal cell layer of hair follicles

Urinary System

Abundant staining was seen in the brush border of the proximal tubular cells

Central Nervous System / Brain

The brain only revealed endothelial and smooth muscle cell staining

Clinical Presentation

Subclinical

Covid & Lung

Covid vs Dengue

Covid & Dengue

Covid & Cardiac

Covid & Intestine

Covid & CNS

Covid & Skin

Kimball A, et al. MMWR (13)69, Apr 3 2020

Confusing Asymptomatic Covid

Sci China Life Sci. Mar 2020

CT SCAN

LABORATORY

GGO CBC, CRP, LDH, SGOT, SGPT, CK

A B C D E

CT scan GGO + + + + +

Leukosit , border N N N N

Trombosit N N N, border

Limfosit

Neutrofil

CRP

Procalcitonin , border

N

-

Local Experience (PAPDI WEBINAR 20/3/2020)

Tools to not overlooked

Cong-Ying Song, et al. medRxiv preprint doi: https://doi.org/10.1101/2020.03.05.20031906.

NLR Cut Off 5.8

Salehi S, et al. AJR 2020; 215:1–7

Tools to not overlooked

- GGO

- Bilateral Involvement

Risk Stratification

NLR Cut Off 3.13

Severity Evaluation

Brescia Covid-19 Calculator

Conclusion

COVID-19 is The 1000 Faces Diseases

ACE-2 Receptor is distributed in various tissue organ

Variety of Symptoms. Not Just Respiratory.

Carefully evaluate the Clinical manifestation, Laboratory pattern, and Imaging as needed

Use Tools

Important to keep updates – Informations and facts are changing so fast

Multidisciplinary TeamWork is A MUST

And Please, Pray to Allah, God Almighty…

Thank You